Fracture reducer



Feb; 5, 1946. J. H. GIEsEN FRACTUBE REDUCER v Filed Jan. 6, 1945 6Sheets-Sheet 1 Fgb. 5, 1946. J. H. GlSEN Y 2 FRACTURE REDUCER Filed Jan.6, 1945 6"SheetsSheet 4 Feb. 5, 1946.

J. H, GIESEN FRAC'I'UREREDUCER Filed Jan', 6,19 5 -6 Sheets-Sheet 5 Feb.5, 1946. J. H; GIESEN FRACTUiRE REDUCE!!- Filed Jan. 6; 1945 6Sheets-Sheet 6 3mm I Patented Feb. 5, 1946 UNITED STATES PATEN T OFFICEp 2,393,982 FRAQTURE REDUCER Josef HLGiesen, United States NavyApplication January 6, 1945, Serial No. 571,643

(Granted under the. act of March 3, 1883, as amended April 30, 1928; 3700. G. 757) 12 Claims.

This invention relates to fracture reducing equipment and moreparticularly to a device whereby fractures may be quickly reduced andexternal reenforcing means appliedby a simple method in such manner thatthe patient may generally be unrestricted in his motions of-the adjacentjoints, and wherebya sufficient support is provided between the brokenfragments of the fractured bone to replace the functions of the bone, sothat the patient "may enerally be re-;

leased from the hospitalimmediately or within comparatively short timeafter'thebone is reduced. I

The object of this invention is to construct a novel, useful andcomplete surgical device for reducing bone fractures, whereby an outerplaster of Paris support may be applied between fixation pins transfixedinto the fragments of the bone by the aid of this device, while thefracture is reduced quickly and easily by the operation of the severalparts of this device before the plaster of Paris is applied.

Another object is to construct a fracture-reducer, comprising mechanismhaving a wide range of application; speed and simplicity in operation;adaptability to a large variety of fractures; adaptability to the use ofvarying sizes of wires, threaded pins and unthreaded pins of varyinglengths, in combination with plaster of Paris, whereby fractures of anybones, accessible by piercing through the outside of the body, may bereadily treated, without the danger of X-ray burns of the hands to theoperator, and'resulting in a considerably shortened period ofhospitalization of the patient.

A further object is to construct, a device for-use in reducingfractures, comprising a base on which are mounted two stirrupassemblies, each of which consists of an outer and an inner stirrup, thestirrups being mounted on adjustably swivelled supports which arelongitudinally adjustable along the base, the stirrups having their endspivoted on a common axis, the outer stirrup being also circumferentiallyadjustable on its support, the inner stirrup being pivotally adjustableabout said common axis, there being a drill shaft assembly mountedthrough the pivoted ends of the stirrups from each side thereof,a numberof carriage assemblies attachable to the stirrups at any selected pointsthereof, and means for universally adjusting the drill shaft assemblieson these carriages, the drill shafts being supplied with No. 1Jacobs-chucks or other similar means for holding the fixation pins whenthey are driven through the bone fragments, said drill shafts alsohaving means for locking them in fixed-position after fixation. I

Other and more specific objects will become apparent as the descriptionof the details of this device-proceeds, having reference to theaccompanying drawings," wherein: I I I Fig. 1 is a side elevational view.of the assembly; Fig. 2 is an end view thereof; I Fig. 3 is a plan viewof this assembly; Fig. 4 is a sectional detail view taken on the 4-4 inFig. 3; V I

Fig. 5 is a section takenalong the line 55 in Fig. 4; I I I Fig. 6 is asectional detail view of one of the drill shaft assemblies through theends of the stirrups, taken along the line 6-- 6 of Fig.1;

Fig. '7 is a sectional view of the gear housing taken along line 1-1 ofFig. 6; I

Fig, 8 is a view of this gear housing with itsv cover in place; I I Fig.9 is a sectional detail view of the split nut and housing, taken alongthe line 9--9 of Fig. 6;

Fig. 10 is a section of this housing taken along line l0|0 of Fig. 9; vFig. 11 is a sectional detail view of one of;the drill shaft assemblies,takenalong the line-l l --l ofFig.2; Fig. -12 is a sectionalview of thedrill shaft through the ends of the stirrups opposite that shown in'Fig.6, and as indicated by the section line l2-l2 of Fig. 3; I

Fig. 13 is a detail sectional'view taken line Iii-l3 of Fig. 4, showingthe splitnut, -releasing screw, and a section of the support swivellingwormwheel; I H

Fig. 14 is a bottom plan view of the slideblock of the support of one ofthe stirrup assemblies; II

Fig. 15 is a plan view of theteeth cut in the outer face of the outerstirrup for its circumferential adjustment; 4 I I I Fig. 16 is asectional view taken along the line line ' Iii-'46 of Fig. 5;.

Fig. 17 is a section throughthe support swivel ling worm casetaken onthe line, lT-Al ofFiglA; Fig. 18 is a sectional view of the ball halvesof the ball and socket joint onone of the drill shaft assemblies; Fig.19 is a sectional view along the 1ine l.9--.l9. .of Fig. ll'showin theconstruction of one of the drill shaft assembly carriages attached to,an inner stirrup. Y p v I Fig. 20 is a perspective viewpf a. lug mightbe used'in' connection withfthepins"or screws of the present inventionfor furnishing a better anchorage thereof in the plasterer Parisalongthe a 2 casts used between the several pins or screws, transfixed intothe fragments;

Figs. 21 and 22 show two views of a modiflcation of the hand screw usedin circumferentially adjusting the stirrup assemblies, whereon aprojection 59 is provided on the end thereof to which a drill may beapplied for speedy operation thereof when desired; and

Figs. 23 and '24 are two enlarged detail views of the end of one type ofthreaded pin which may be used in combination with the present device.

Referring now more specifically to the several figures of the drawings,in which like parts are designated by the same numerals; the device iscomposed of two stirrup assemblies, each of these consisting of an outerstirrup I and an inne stirrup 2 shaped in a half circle; the innerstirrup revolves about the common axis 3 with the outer one in suchfashion that a complete circle may be described about the fracturedmember to which the device is applied. In most instances, such acomplete circle is unnecessary. A unit-4 refer-red to asfthe carriageassembly may be attached to the inner stirrup-or the outer-one, and thusa bone fragment may be approached almost at any degree in the circle.The carriage assembly has constructed'within it,a ball and socketmechanism 5 which allows furthe choice of site of insertion of the pin 6or'screw fi".

An illustrative "form of the threaded pins or screws 6' is shown inFigs. 23 and 24. It is a combination drill, tap and screw. The drillportion 60 and tap portion 6| are made very short so as to obtain aminimum penetration of the bone before firm grip in the bone isestablished by the screw portion. A combination of this type makestransfixion of screws through bone structures much easier and quickerand eliminates the dangerof excessive traumatization of the patient.Besides insertion of straight threaded pins, the drill assemblies shownin this device may be used for inserting headed bone screws such as theSherman bone screws and others, by inserting a special type of screwdriver blade in the chuck having a novel bone screw holder attachment,which-is made the subject of another application Serial No. 582,476,filed March 13, 1945.

These bone screw are preferably modified at their ends to formacombineddrill, tap and screw. The use of this combinationo'f drill, tap andscrewhas the advantages of less chances of burning of the bone tissues whichoften results in :a prelim inary drilling operation where thiscombination is not used. Also there is no separate drilling operationnecessary, and a minimum amount of force is'necessary in transfixioneven of the larger sizes of screws since the proper size drill and tapare always combined with any screw size. a

The above-mentioned stirrup. assemblies are adjustably supported on abase 1 in such fashion that the latter allows a maximum ofv approximately 20 inches and a minimum which may be as little as 3 inchesbetween the two sets of the stirrups. This sliding movement may bequickly effected by releasing the so-called half-nut mechanism 8 fromthe threaded screw 9 in the base. This is done by turning the knurledknob to of the turnbuckle screw J I If a slow, steady, powerful movementof the stirrup assembly is desired, the half-nuts may be quicklyattached to'the traction screw 9 in the base by merely turning the'knobIn in the opposite direction. By turning the hen:

'dles at either end of the basaa slow steady movement of considerablepower may be afiected,

. A 5 i I! robtaining traction to any desired degree. By reversing thedirection of thehandles, compression of the bone fragments may beobtained. In actual operation, one stirrup assembly is allowed to remainstationary and by means of a gauge as, registering in pounds, the pullor traction in terms of pounds is always known to the operator. Nodanger of rupturing blood vessels or nerves is present by excessive pullupon the fragments. This gauge should be calibrated and register up to40 pounds traction. Sterilization is likely to damage the mechanism inthis gauge, and arrangements should be provided for removing it duringsterilization.

Two screws are generally inserted into each bone fragment of single,long bones for full control thereof. The pivots M of the inner and outerstirrups at their common axis 3 are so constructed that theywilleachaccommodate a drill shaft assembly. This assembly has a chuck l5permanently attached to it for mounting a pin, wire, or screw 6 therein.This chuck should be of the type of construction as the No. 1A Jacobschuck,

and is the same for all of the'carriage assemblies.

In other words, although :all of the pins andscrews may not lie in thesame plane, 'the'irinsertion is identical by identical means. I One pinor screw is carried by a drill shaft assembly on a carriage I! t, theother by the drill shaft assembly o assemblies in the pivoted ends 'I '4of the inner and outer stirrups. It will be further noted that each setof stirrups with its attachments is identical to its opposite, half notonly from the standpoint of construction, but also from the standpointof operation. I

The outer stirrup I has gear teeth I! machined alongits outer surface.for the purpose of articulating with the gear in .a gear box t9 whichforms a part of the support beneath the :stirrup's. This gear boxcontains a worm 18 .attached to the handle 22. By these handlescontrolled axial rotation of either bone fragment is obtained. The :gearratio used in the present device is 25: 1. The gear box above-referredto is in turn attached to another gear box 23 within thesupport for the:stirrups, lying directly beneath the first one; Thisgear'box alsocontains a worm 24 and wormwheel 25 attached to handle 2 6. 'A fragmentI depress as the inner stirrup i turned about the common axis; that is,controlled rotation in a vertical plane-through the axis of the bone'is'thus obtained. The handle controlling this motion may be seen .at.21. A gear ratio of 72:1 is used here. r

Traction is obtained 'as before-mentioned by turning the handle l2attached to the traction screw 9 in the base, thus it'is seen that thereis elevation or depression, motion to the right or left, and axialrotation of about of either fragment, which controlled motionwill'reduce any fragment, providing 'sufiicient power is present .in thedevice to overcome the resistance :of the muscles, fasciae, etc. By" theuse of the above-mentioned :gea'r ratioslas well as by the powerfulscrewmechanisms, the traction :screw or the base, and those'of thehalf-nut mechanisms,

be easily overcome.

any excepting the most severe resistance should Each of the handlesconcerned in these operations should be about 2% inches in length. Thusthe fragment ends may be accurately and quickly approximated.

The basic mechanical principles of this device are sound. Its operationis simple, in that each half of the device is identical to the otherhalf, and that no matter what the site of the fracture, the screws orpins or wire used are all inserted in an identical fashion. Itsapplication to a fractured member is quick, requiring no longer thanfifteen minutes in most cases. It is believed that fractures, by the useof this device, may be reduced quickly, easily, and safely with aminimum of operative risk, a minimum period of hospitalization, aminimum of hospital days, with the aid of a minimum of medicalpersonnel, thereby releasing the latter for duties elsewhere. The use ofthisinstrument has simplified the treatment and handling of largenumbers of fractures incident to modern war. In connection with the.

use of this device, circular plaster of Paris casts extending only. farenough to incorporate the pins should be used, so as to permit jointmotion above and below the fracture site. In simple fractures, plasterof Paris splints will prove sufficient.

This surgical device is an instrument designed to handle practically allfractures of long bones such as the femur, the tibia, the fibula, all ofthe leg. Similarly, it will handle fractures of the humerus, the radiusand the ulna, all of the arm. In addition, the reduction of thefollowing special fractures may be effected through its use: the collarbone or clavicle, the bones of the forearm, the metacarpals of the hand,the femoral neck, the Potts fracture, the metatarsals No. 1, 2, 3, 4 and5 of the foot, and the s calcis. The manner in which these specialfractures are handled throgh the use of this instrument will behereinafter described.

- This fracture reduction instrument may be used over and over againwithout sacrificing any of its parts; that is to say, the .pins, screws,or wire which are transfixed into the bone subsequently to beincorporated into the plaster of Paris bandage are the sole items ofequipment which are sacrificed. Small lugs 28' which were designed toaugment the fixation of these screws and wire or pins are likewisesacrificed, but these are not part of the instrument, being onlyaccessories which positively insure fixation of the pins, etc., in theplaster bandage. The pins, screws, and lugs may be salvaged after theplaster of Paris bandage is removed. Those which have been used havebeen chromium plated in order to safeguard them against rust anddeterioration, and. may be used over and over again. It will be observedthat no matter what the site of fracture or the size of the bone inquestion, no other piece of equipment is required other than a drill,which must obviously be used in the insertion ofscrews or pins or wireinto the bone, whether by this or any other method.

The wires, pins, or screws may be made of corrosion resistant steel andmay be made in any machine shop, as the threads arestandard ones. Thesemay be cut to the desired lengths. In this instrument either threadedpins, wires, or screws may be .used. This instrument has its chucksconstructed sothat anyone of the sizes, 59,, and inches may be' equallyaccommodated; .This' instrument can accommodatev pins for screws up tolengths .of nine inches.

By the use of this instrument, open operation now often required in thetreatment of the fractures' mentioned abovewill be unnecessary. Inthirty minutes all. except the most complicated fractures should bereduced, plaster of Paris bandage applied, the instrument detached andready for use again. This feature is obviously of tremendous benefit inwartime. The. long periods of hospitalization and tediou after-care andthe danger of long anesthesia should be unnecessary. In short, its usewill lessen the burden of the surgical staff wherever it is used. Casesof fracture of the upper extremity should be up and about in twenty-fourhours, and those of the lower extremity within 48 to 7 2 hours with orwithout crutches. This is obviously an ideal method under modern warconditions when the older methods of treatment must be dispensed with.Patients so treated are made ambulatory and self-sufficient, and idealas compared with immobile, insu'mcient ones. i

The entire instrument may be sterilized in any ordinary sterilizer inthe usual surgical setup. This instrument further allows a marked degreeof latitude as regards the site of fixation of the fragments; thusseptic areas, burned areas, and unhealthy skin may be avoided. Three ormore pins may be inserted instead of two if desired. By its use, X-rayburns of the operatorshands will not occur, as the manipulation offragments is done mechanically'at some distance from the X-ray tube.

Referring again to the drawings the drill shaft assemblies mounted inthe pivoted ends of the stirrups are axially lined up. Each drill shaftassembly is composed of a drill shaft 20 on the inner end of which achuck I5 is mounted, and the outer end 2| of which is adapted forconnection to a drill for turning the shaft. The shaft is slidablymounted within a sleeve having an outer thread 28 and an axial groove 29registering with the key 30 for guiding the sleeve axially within thesleeve 3| to which the end of the inner stirrup 2 and the worm gear 32are rigidly connected. The sleeve 28 has a clamp' means 33 at its innerend, its outer end 34 being knurled for manual axial adjustment uponlifting of the half-nut 35 from the thread 28 by operation of the cams36 through the squeeze levers 31 on the outside of the half-nutmechanism casing 38. The casing 38 is knurled around its periphery toprovide a good grip for manual operation thereof. This casing is mountedon the sleeve 39 rotatably attached to the wormwheel casing 40 and has aflange 4| therein for restriction against axial movement.

Relative rotation between the stirrups for preliminary setting of thestirrup 2 about the axis 3 isobtained by loosening the knurled nut 42and manually turning the stirrup 2 to any approximate position desiredand then retightening nut 42 to bring the corrugated faces 43 intoregistry again in the new position. For finer adjustment of the angularrelationship between the inner and outer stirrups the handle 21 fixed onthe end of the shaft of the worm 44 is turned whereby a fine adjustmentof the wormwheel 32 and the stirrup 2 through the intermediateconnections is obtained, together with the simultaneous adjustment ofthe drill shaft assemblies.

In operation when it is desired to turn the drill shaft the clamp 33 isloosened and a drill is applied to the end 2|, the shaft being free tomove axially to any position' desired while the drill is operated.Upon'completionof the drillmg operation the clamp 33 is tightened, and'if a quick axial a justment is desired the. halfnut 35 is lifted offthe thread 28, and; by means of the knurled. end the drill shaitassembly may be quickly moved axially to any new position desired. Forfiner axial adjustment of this assembly the half-nut housing 38 isturned by hand after allowing the halt-nut to engage the thread 28.

number of drill shaft assemblies maybe provided with this instrument,with carriages for mounting them on. either. of the stirrups. Theseassemblies have a similar constructionto the above assemblies with.respect to their axial aifiustment and operation by a drill. but aremounted in. a ball. fitting comprising the ball and socket joint Thesocket portion isintegral with the carriageib which may be slidablyattached to the'stirrup. This carriage has a piece- 45' forming theouter end of. a. clamping: groove and has two guide pins- Hi and 41"affixedthereto and slidable inrbores 41' and 4.8 respectively within thecarriage. "A third pin 49 is also af-- fixed thereto in parallelrelation to the other pins, andjpasses through a parallel bore: theother end. of which is countersunk. The. end of this pin extendingwithin, the counterbore is threaded. Another piece 58 of the carriage ishinged at 54 thereto, and forms the outer half of: the ball socket;having a; bore at its outer end, through which a clamping screw. havinginner threads fitting over the threaded pin l-Qis passed for clampingthe ball andv socket joint, by tuming: the handle 52, .fixed to saidclam-ping screw. Thus it; may be. seen. that this screw may be used forsetting the drill assembly at any desired point of either stirrup andturned in any angular direction with respect tothe bone fragments, sinceit operates on boththe ball and socket joint as well as on the clampingmeans to the stirrup.

The ball joint or the ball and socket: fitting is made up of two halves5d and 54, joined by dowel pins 55; and; has a. setscrew 56 incorporatedtherein, which has an extension. lug 51' that fits into the'axial groove58, which serves'the same purpose in this drill: assembly as: the groove29 in the drill assemblies'previously described. In. this case howeverinstead of the: key 30,, the lug; 5'! is used cooperation with. groove.

Any suitable connection may be made between the: gauge i3 andithetraction screws! whereby the force exerted between the ends of. thesetraction screwsis transmitted to the gauge and. indicated thereonior:continuous observation. A. brief description of the use of the presentdevice will now be given in illustrative fracture cases.

In the case: of fracture of the radius, the patient madeto lie down,face downward; the instrument is broughtal'ong side with the innerstirrups in raised position. and thearm inserted through both stirrupassemblies; Two carriage assemblies are attached tothe: proximal. innerstirrup; One or these may be substituted by one; or the axial drillassemblies mounted the ends of the: stirrups. Likewise, in the stirrupassembly nearest the end, twodrillrassemblies are used. The oper-.ation. and. reduction. of this, single, long. bone: is identical: withthat of any other long, bone merely by turning handles 22,. 2.6;, 21 andf2 in the base,

until approximationhas been eilected.

In the case of av fracture of. thezclavicle, the. instrument. is appliedby moving it near the patients' head while-he isreclining onhis'back; Asaudbag'isi placed beneath: the vertebral column high. up "between the.shoulder blades, This is.

done in order to reduce'the fragments. as much as possible; In thisfracture, one. fragment is generally depressed and the other relativelyelevated, and one lies generally inv front of the other.v A carriageassembly is attached to the inner stirrup in each half of theinstrument, and these are brought into close approximation to theshoulder blade. The. ball and socket mechanisms are made fast by turningthe thumb screws. By turning thehandle [2 in. the base, theiragmentsmove anteriorly oppostcriorly, respectively. By tuming thehali-nut'mechanism. in the carriage assembly; the fragments are elevatedor depressed. Small threaded pins'are: used. After reduction isefiectecl, a felt. pad is placed over the clavicle, a

plaster of Paris splint is applied over the clavicle incorporatingwithin it the screws with lugs at;- tached thereto, in. order thatpositive fixation will be obtained. The chucks are detached, and inturn. the device is detached.

In the case of a fracture of. the metatarsal No.v l or othermetatarsalsnol the foot, the instrument is applied by placing it nearthe bottom of. the foot, the patient lying on his back, with the ends ofthe stirrups straddling the foot in a position so that a pin may bedriven through and through the forefoot and held by lugs at its ends,mounted on' screws held by chucks of two" drill assemblies, fixed in.carriages mounted on. the: inner stirrup of the outer stirrup: assembly.A pin is driven into the lower quarter of the tibia for-the purpose offixation- .The inner stirrup assembly. is aligned sov that the twocarriage assemblies mounted axially in :the. ends of these stirrups. areattached and. properly aligned with this. pin, so that by turnmg thehalf-nut mechanisms on the inner stirrup assembly, traction is: exertedupon. the pin driventhrough. the metatarsals- It is to be noted that thescrews are threaded into the lugs abovementioned, so as to rigidly fixthem thereto. Plaster of Paris bandages are then applied so as toincorporate the screws: and the: lugs. Theiinstrument is then detached.

In the case of a fracture of the os calsis; the patient is: made to lie:on his back and the instrument is moved under the foot. Only oneof thestirrup. assemblies is necessary for this operation. A pin is driventhrough the os: calsis. Lugs are attached to this pin. A screw istransfixed into the. lower quarter of the tibia for: purposes offixation of. the foot: and ankle, on the axis of the stirrup assembly.The inner stirrup is: aligned and two carriage assemblies are attachedto it and aligned to conform with. the direction of the desired pull,.such. that the so-called salient angle of approximately 30 will be.restored and that: the normal arch made by the os calsis: and the othertarsal bones: approach the normal. The screws of the two: carriageassemblies are threaded into the lugs. The. pins driven. into the tibiaand os calsis with lugs attached. are then incorporated into a. plasterof boot. The device is detached by releasing the chucks from the pinsand the instrument removed.

In thercase of a Potts fracture, the instrument; is positioned. in thesame manner as before, using only one of. the stirrup assemblies. forthe operation, whilethe other stirrup: may be used as a support.under'thecalf of the leg. The lower fragment of the fibula is transfixedby two threaded pins, one. in the pivot of: the inner and outer stirrupends, the other in a carriageas semblyattached to: inner: stirrup.vOnlyone of the'stiirup-assemblies isnecessary in the reduction of thistype of fracture just as in the above operation. This fragment iselevated or depressed. The fragment is brought inwardly or outwardly byturning the handle 21. Axial rotationis effected by turning handle 22.Over-ride of the lower over the upper fragment is corrected by turningthe handle attached to the traction screw in the base. It will be notedthat the upper fragment which is long and generally not depressed doesnot require manipulation. If 'it does require manipulation, the upperstirrup may be used for this purpose. The threaded pins in the fibulawith lugs attached are then incorporated in a plaster of Paris bootwhich is applied in such fashion that the medial malleolus is notincorporated into the plaster but left free for subsequent transfixationby a threaded pin, as will be later described. The chuck is released andthe carriage assembly is detached leaving the threaded pin in the axisof the inner and outer stirrup ends attached. The reason for this willbe seen in the following description.

The next step is to rotate the inner stirrup away from the foot through90 more or less. The carriage assembly is reattached to the innerstirrup and aligned so as to point from the inner side of the foottoward the fractured tip of the inner ankle bone. A small threaded pinistransfixed thereby into the fractured tip, purposely left free fromplaster applied during the first step of this operation. By means of thehalfnut mechanism in the carriage assembly, this fractured tip of thetibia is approximated to the side from which it was broken. A lug isattached to this threaded pin and the plaster of Paris bandage is thencompleted, incorporating the third threaded pin and'its lug. The chucksare detached from the threaded pins and the reducer is removed. l

In the case of a fracture of both bones of the forearm the patient ismade to lie down on his face and the instrument is moved over the armthe inner stirrup being moved into the raised position. Seven fixationscrews are used in this operation. In all other fractures of long bones,two screws are used,.one into each fragment for full control. This isnot possible here, inasmuch as the elbow, the radius and the ulna do notlie in the same plane and therefore only three or four pins can be usedthrough the axes of the inner and outer stirrups. s

In this operation, one or the other of the long bones of the forearm,preferably the radius, is reduced. It will be noted that in the fractureof both bones of the forearm four fragments are present instead of two,as in the ordinary fracture of a long bone, and therefore the problem istwice that seen in a fracture of one long bone. This is overcome by theso-called half-nut mechanism constructed into the device. The tworemaining fragments, after the radius is reduced, are controlledcompletely in elevation or depression and side to side motion by turningthe half-nut mechanisms. It is obvious there fore that the best positionof the screws of the last two fragments, is the position of 90 one tothe other, so that a true upward-downward and atrue lateral position maybe obtained. Final approximation of the aligned bone ends is thenbrought about by turning the handle on the traction screw in the base.Lugs are applied to the screws and all seven of theseare incorporated inthe plaster of Paris bandages. It will be well to note that in all othercases of fracture of singlev long bones, manipulation of the fragmentsby the half-nut mechanism is unnecessary, as full control of thefragment is obtained by gear mechanisms constructed into the device.That the halfnut is necessary in the fracture of both bones as well asin other separate features, is obvious because of the multiplemechanical problems involved. It will be noted that by compressing thehandles controlling the half-nut mechanisms, a rapid cross movement ofthe drill rod is obtained, and then when these handles are released,they look themselves. Fine adjustments are thereupon obtained by merelyturning the half-nut mech anism serrated knobs. After the plaster ofParis is applied and set the device is removed in the usual manner.

In thecase of a fracture of the neck of the femur, the instrument isapplied under the thigh and the stirrup assemblies are adjusted-andscrews attached so they may be'applied' to the fragments. Theheel-to-palm test is applied to insure that the fractured femoral neckhas been reduced (using the Whitman or Leadbetter technique). With theleg internally rotated, abduc tion with the instrument is necessary,this having I been done by hand. The instrument is used merely as a jigto insert two or more'wires or threaded pins.

In the case of fracture of the femoral shaft, the instrument is appliedas above. and four threaded pins are used. These are transfixed into theregions of the greater trochanter and the lateral epicondylar regions ofthe upper and lower fragments respectively. The patient is placedpreferably upon an adjustable surgical table so that the instrument maybeadjusted to his extremity quickly. The well leg must be convenientlysupported. Over-ride in this case is corrected by turning the basetraction screw handle. Elevation and depression of the fragment isvcorrected by turning the inner stirrups handle. Rotation of eitherfragment along the axis is corrected by turninghandle 22 while lateralmedial displacement of either fragment is corrected byturning handle 26.It will be obscreen.

In the case of a fracture of the metacarpal No. 1 (or othermetacarpals), the instrument is placed under the fractured hand, onlyone stirrup assembly being necessary, and a small screw is threaded intothe mid-phalynx of the thumb prior to insertion of the screw into thelower end of the radius. The inner stirrup is turned over the forearmand a small screw is transfixed into the lower end of the radius bymeans of the drill shaft mounted on the axis of the stirrups. A carriageassembly is attached to the inner stirrup over the forearm and isaligned so that the direction of pull will be in the long axis of thethumb; A screw mounted in the chuck of this carriage assembly isthreaded into a lug mounted on the screw inserted into the mid-phalynxof the thumb. By turning the serrated knob of the half-nut in thiscarriage assembly, traction in this direction will be obtained andover-ride corrected. Manipulation of the fragment is pos-' support,means for adjusting the inner; stirrup the wrist and lower portionQfith'e thumb leaving fingers}, 3-, 4 and} 5 free for use. Thus it isseen that any single finger -may be reduced in exactly" the same mannerand fixed in plaster of Paris bandages, leaving the- ,other' fourfingers free for use;

Y Similar operations are performed for other fractured bones of theextremities: or elsewhere, and the use of the instrument may be greatlyextended after some practice, to regions of the body which are moreinaccessible; also, better technique is developed with more experiencein all of these;- operations;

This instrument may beprovided witha carry ingpcase of suitable. shapeand size, havinga drawer constructed into its lower portion, to ac-.commodate pins, screws, lugs and'detach'ecl carriageassemblies. Thevarious parts of this device may be dimensionediin accordance with thespecific applications for which they are intend": ed, and manymodifications form and arrange V ment' maybe made without departing fromthe spirit and scopeof this invention, as defined in theappended claims.o t 7 It is to be observed that in caseswhere swelling is present theapplication of the" plaster of Paris may be postponed and the pins orscrews held in place by keeping the reducerdevice' attached for some.time untiI the swelling goes down. The plaster of Paris is thenappliedand the reducer detached.

, The invention described herein may be manufactured and used by or forthe Government of the United States of. America for governmental;purposes without the payment of anyroyaltiesg thereon ortherefor.Iolaim:v 1. Ina fracture reducer, a base, a slidable sup-i port thereon,means for sli'dab'ly adjusting said support, said support having aswivelled upper, portion, means for adj'ustably turning said upperportion, a pair of semi-circular stirrups concentrically joined bypivots at their ends, the outer stirrup being circunrferentiallyadjustable on said" angularly about said pivots, a drill shaft assemblyaxially mounted through each pivot, and. one. or'more carriages foradditional drill shaftassemblies having clamping means for mounting uponsaid stirrups. 2. In a. fracture reducer, a base,a slidable supportthereon,.means for slidably adjusting said support,v said support havinga swivelled. upper portion, means for adjustably turning said upperportion, a pair of semicircular stirrups concentri'cally joined bypivotsat their ends, the outer stirrup being circumierentiallyadjustable oncsaid support, means for adjusting. the inner stirrup.

' angularlyabout said pivots, a drill. shaft assembly axially mountedthrough each pivot, oneor more:

j carriages for additional drill shaft assemblies having clamping meansfor mounting upon: saidstirrups, each of. said: drill shaft assembliescomprising-a drill shaft, a chuck. mounted on the end of said shafthaving means for tightening" over I a drill or pin; inserted therein,which will not loosen upon reversal of direction of operation ofsaidd'rill, said drill shaft having its other end f adaptable forreceiving a, drillto operate it, 1 clamping means for'fixing said drillshaft against portion, a pair of semi-circular stirrups concen- Vtri'callyjoined by pivots at their ends, the outer stirrup beingcircumferentially adjustable on said M support, means for adjusting theinner stirrup .angularly about said pivots, a drill shaft assemblyaxially mounted through each pivot; oneor more carriages for additionaldrill shaft assemblies having clamping means for mounting upon saidstirrups', each of said arm shaft assemblies comprising a drill shaft, achuck mounted on; the end of said shaft having means for tightening overa drill or pin, inserted therein, which will not loosen upon reversal ofdirectionzof. operation offsaid' drill, said' drill shaft having itsother end adaptable for receiving a drill to operate it,clampingmeansgfor'fixing said drill. shaft against saiddisplacement, andmeans for axially individuallyadjlusting said drill assemblies, saiddrill 2d shaftjassemblies mountedj at the pivots being adjustable withthe inner 4. In a fracture reducer; a base having two supportsandstirrup assemblies such as claimed inclaiml. V j

5; In a. fracture reducer, a. base having two supports and stirrupassemblies such as defined in. claim 2;

6. Ina fracture reducen, a base having two supports and stirrupassemblies such as defined.

in claim 3.

7 Airacture reducer suchas definedin claim 1, wherein the means forslidably adjusting. the supportcompri'ses a threaded shaft operated byahandleat one end thereof. and passing through a half-nut mechanism insaid support, andmeans for lifting the halves of said half-nut from.said. threaded shaft, so as to beahle. to quickly move said support to.anew position without the: necessityof'turning. the threaded shaft.

8'. Afracture. reducer such as defined in claim 1, wherein the meansforslidably adjusting the sup-- port comprises a threaded. shaft operated.by ahandle at one end thereof and passing through a. half-nut. mechanismin said. support, and means. for lifting the halves of said half-nutfrom said threaded shaft so as to be able to quickly move said supportto a new position without. the necessity of turning. the threaded shaft,and wherein the means. for turning the upper portion. of

said. support comprise a worm. operated by handle supports and stirrupassemblies such as claimed in claim 1,. said drillv shafts on thecarriages being supported in. ball and socket joints for universaladjustment, which joints have clamping means tightening simultaneouslywith the "carriage clamps on the respective stirrups by a commontightening means, the drill shaft of each drill shaftassembly'being'slidably mounted a sleeve.

on which said drill shaft clamping means are of said outer stirrupfixed, said sleeve having an outer thread passing through a half-nutmechanism and having an axial groove for axially guiding it through theball joint, means fixed to said ball joint extending into said groove, ahousing for said half-nut mechanism rotatably connected to said balljoint but restricted against axial motion relative thereto, and havingguides for turning said half-nut therewith and means for lifting thehalves of said half-nut from the threaded sleeve for quick axialadjustment of said sleeve.

11. In a fracture reducer, a base having two supports and stirrupassemblies such as defined in claim 3, means for angularly adjusting thedrill shaft assemblies mounted at the pivots together with the innerstirrup about said pivots, comprising a worm and wormwheel housing fixedto the outer stirrup, a wormwheel mounted therein and connected to theinner stirrup and a worm meshed with said wormwheel within said housinghaving a shaft extending therethrough and an operating handle fixed tothe end of said shaft on the outside of said housing.

12. In a fracture reducer, a base having two supports and stirrupassemblies such as defined in claim '3, means for angularly adjustingthe drill shaft assemblies mounted at the pivots together with the innerstirrup about said pivots,

comprising a worm and wormwheel housing fixed to the outer stirrup, awormwheel mounted therein and connected to the inner stirrup and a wormmeshed with said wormwheel within said housing having a shaft extendingtherethrough and an operating handle fixed to the end of said shaft onthe outside of said housing, and a separable coupling in the connectionbetween the wormwheel and the inner stirrup assembly comprising annularcorrugated faces and a lock-nut for interlocking said faces, wherebyupon loosening said lock-nut the stirrup assembly may be quickly turnedto a new angular setting and the lock-nut retightened for furtheradjustment by the worm 20 handle.

JOSEF H. GIESEN.

